14 Juvenile idiopathic arthritis: osteoporosis and fractures

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common inflammatory arthritis in children. Chronic inflammation, as well as the various treatments used during JIA increase the risk of occurrence of osteoporosis (OP) and fractures. Objectives The objective of this work was to determine the frequency of OP in JIA and to investigate the factors associated with its occurrence. Methods This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). We collected sociodemographic and anthropometric parameters, clinical data, results of biological assessments, bone densitometry results and data on prescribed therapies. We compared these variables according to the bone densitometry profile to assess the factors associated with OP in JIA. Results There were 29 patients (17 females and 12 males), the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. Three patients were smokers. The mean BMI was 21.20 ± 4.88 [14.17–27.55] kg/m2, and 4 patients had a BMI ≥ 25 kg/m². The polyarticular form was the most frequent, noted in 55.2% of cases (n = 16). NSAIDs, corticosteroids and methotrexate were prescribed in 62.1%, 69% and 79.3% of cases respectively. OP was found in 24.1% of cases (n = 7). Mean T-score values at the lumbar and femoral sites were −2.20 ± 1.22 SD and −2.31 ± 0.97 SD, respectively. Six patients suffered at least one fracture. Patients with OP had lower BMI than patients with normal bone density (17.02 ± 2.46 vs 23.91 ± 5.42; p = 0.046). Furthermore, absence of rheumatoid factor was associated with OP in our study (83.3% vs 16.7%; p = 0.008). On the other hand, the following parameters were not associated with the occurrence of OP in our study: age, gender, smoking, age at onset and duration of progression of JIA, BMI, extra-articular manifestations, CRP, antinuclear antibodies, ACPA and erosive character. Regarding the treatment received (NSAIDs, corticosteroids and methotrexate), no difference was found between patients. Conclusion Osteoporosis in JIA is common and has a prognostic impact. It must be systematically screened throughout the follow-up. In our study, OP was associated with the absence of rheumatoid factor and was more frequent in patients with low BMI.


Background
Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease. Although, some patients achieve remission, some cases of JIA may persist into adulthood. Patients with JIA and other inflammatory joint diseases have increased cardiovascular disease risk compared with the general population.

Objectives
To study the cardiovascular risk factors in JIA and their association with disease parameters. Methods This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years . We collected sociodemographic and anthropometric parameters, clinical data, results of biological assessments, and data on prescribed therapies. We studied the following cardiovascular risk factors: family history of cardiovascular event, physical inactivity, smoking, arterial hypertension, diabetes, dyslipidaemia and obesity.

Results
We included 29 patients. The M/F sex ratio was 0.71, the mean age was 35.69 AE 11.72    -218] mg/l and biological inflammatory syndrome was present in 19 cases. Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively. Corticosteroid therapy and NSAIDs were prescribed to 18 of the subjects. Cardiovascular risk factors were present in 41.4% (n ¼ 12) of cases: family history of cardiovascular event (n ¼ 2 cases), physical inactivity (n ¼ 5 cases), smoking (n ¼ 3 cases), arterial hypertension (n ¼ 4 cases), diabetes (n ¼ 4 cases), dyslipidaemia (n ¼ 4), and BMI ! 25 kg/m 2 (n ¼ 4). Following parameters were significantly higher in patients with cardiovascular risk factors: the presence of a biological inflammatory syndrome (81.8% vs 35.3%; p ¼ 0.016), the frequency of prescription of corticosteroids (91.7% vs 52.9%; p ¼ 0.026) and NSAIDs (83.3% vs 47.1%; p ¼ 0.047). However, no significant difference was noted when comparing these parameters: gender, age, age of disease onset, disease duration and presence of extra-articular manifestations. Moreover, cardiovascular risk factors were not associated with the presence of rheumatoid factor, ACPA, and antinuclear antibodies. Conclusion Inflammation, corticosteroid therapy and NSAIDs are associated with the presence of cardiovascular risk factors in JIA. The evaluation and control of this risk must be regular during patient follow-up. Control of inflammation and rationalization of treatment are necessary.

Background
Juvenile idiopathic arthritis (JIA) is the most common inflammatory arthritis in children. Chronic inflammation, as well as the various treatments used during JIA increase the risk of occurrence of osteoporosis (OP) and fractures.

Objectives
The objective of this work was to determine the frequency of OP in JIA and to investigate the factors associated with its occurrence.

Methods
This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years . We collected sociodemographic and anthropometric parameters, clinical data, results of biological assessments, bone densitometry results and data on prescribed therapies. We compared these variables according to the bone densitometry profile to assess the factors associated with OP in JIA.

Results
There were 29 patients (17 females and 12 males), the mean age was 35.69 AE 11.72   The polyarticular form was the most frequent, noted in 55.2% of cases (n ¼ 16). NSAIDs, corticosteroids and methotrexate were prescribed in 62.1%, 69% and 79.3% of cases respectively. OP was found in 24.1% of cases (n ¼ 7). Mean T-score values at the lumbar and femoral sites were À2.20 AE 1.22 SD and À2.31 AE 0.97 SD, respectively. Six patients suffered at least one fracture. Patients with OP had lower BMI than patients with normal bone density (17.02 AE 2.46 vs 23.91 AE 5.42; p ¼ 0.046). Furthermore, absence of rheumatoid factor was associated with OP in our study (83.3% vs 16.7%; p ¼ 0.008). On the other hand, the following parameters were not associated with the occurrence of OP in our study: age, gender, smoking, age at onset and duration of progression of JIA, BMI, extra-articular manifestations, CRP, antinuclear antibodies, ACPA and erosive character. Regarding the treatment received (NSAIDs, corticosteroids and methotrexate), no difference was found between patients. Conclusion Osteoporosis in JIA is common and has a prognostic impact. It must be systematically screened throughout the follow-up. In our study, OP was associated with the absence of rheumatoid factor and was more frequent in patients with low BMI.

Methods
We conducted a retrospective study including adults with longstanding JIA according to the International League of Associations for Rheumatology (ILAR) criteria. A detailed questionnaire was completed for each participant by interviewing them as well as by information obtained from their medical records. We identified among the adult patients, those who are married, their age at marriage, the number of gestation and parity, the age of the first child, miscarriages, and occurrence of menopause.

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